| 儿童溶血尿毒综合征的血液净化治疗 |
| 投稿时间：2018-03-10 修订日期：2018-04-03 点此下载全文 |
| 引用本文：胡小涵,张玉桦,陈丽虹,林洪洲,余灵芳,杨青,庄捷秋.儿童溶血尿毒综合征的血液净化治疗[J].医学研究杂志,2018,47(9):34-38 |
| DOI：
10.11969/j.issn.1673-548X.2018.09.009 |
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| 基金项目:国家自然科学基金资助项目（81170709）；浙江省自然科学基金资助项目（Y2080291） |
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| 中文摘要:目的 探讨血液净化在儿童溶血尿毒综合征（HUS）中的治疗价值。方法 收集2000年1月~2017年1月温州医科大学附属第二医院、育英儿童医院收治的12例应用血液净化治疗的HUS患儿的临床资料。其中8例患儿予以血浆置换（PE）治疗，4例在此基础上联合连续性肾脏替代治疗（CRRT）或血液透析（HD）；4例患儿单独行腹膜透析（PD）。回顾性分析其治疗前后的临床和实验室指标变化、治疗不良反应及其预后情况。结果 经血液净化治疗，除1例（8.3%）患儿合并呼吸衰竭转院后失访，11例（91.6%）临床表现均改善。治疗后血红蛋白、血小板、血清尿素氮、肌酐、尿酸、乳酸脱氢酶水平、总胆红素及间接胆红素等实验室指标均好转（P<0.05）。8例（66.7%）患儿遗留蛋白尿、伴/不伴镜下血尿。3例（37.5%）患儿PE期间出现过敏反应。1例（25%）PD的患儿继发急性腹膜炎。随访期间，2例（17.4%）出现病情复发，其中1例再予多次PE后好转。结论 PE、CRRT、HD及PD等血液净化治疗能够缓解HUS患儿的临床症状、改善血液学及肾功能指标，是治疗儿童HUS的有效方法。 |
| 中文关键词:溶血尿毒综合征 血液净化 血浆置换 肾脏替代治疗 儿童 |
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| Blood Purification Therapy for Children with Hemolytic Uremic Syndrome |
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| Abstract:Objective To investigate the therapeutic value of blood purification in children with hemolytic uremic syndrome (HUS). Methods The clinical data of 12 HUS children treated with blood purification were collected from January 2000 to January 2017 in the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University. Among them, 8 patients were treated with plasma exchange (PE). 4 patients were combined with continuous renal replacement therapy (CRRT) or hemodialysis (HD). 4 patients were treated with peritoneal dialysis (PD) alone. Results After blood purification treatment, except one case with respiratory failure was lost to follow-up after transfer, the clinical manifestations of 11/12 cases(91.6%) were improved. After treatment, Laboratory indicators comprising hemoglobin, platelets, serum urea nitrogen, creatinine, uric acid, lactate dehydrogenase, total bilirubin and indirect bilirubin were improved (P<0.05). 8/12 cases (66.7%) of patients still had residual proteinuria, with or without microscopic hematuria. 3/8 cases (37.5%) had allergic reactions during PE. 1/4 case (25%) who underwent PD had acute secondary peritonitis. During follow-up, 2/11 patients (17.4%) had recurrent disease, of which 1 patient was treated with multiple PE and then improved. Conclusion Blood purification therapy such as PE, CRRT, HD and PD can improve the hematology and renal function and relieve the clinical symptoms in HUS children, which is an effective method for the treatment of HUS. |
| keywords:Hemolytic uremic syndrome Blood purification Plasma exchange Renal replacement therapy Child |
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